Therapy

This page is still under construction so I apologize for the lack of info here. Will be gathering more and adding it in soon.

Seasonal Affective Disorder and Light Therapy

What is seasonal affective disorder?
Seasonal affective disorder is a major (serious) form of depression that occurs at the same time each year. Researchers have identified two types of SAD. The most common type, known as "winter depression," usually begins in the late fall to early winter months and ends in spring. Seasonal affective disorder can also occur in the summer (known as "summer depression").

Surveys estimate that 4 to 6 percent of the general population experience SAD. Women with SAD outnumber men four to one. The disorder usually begins in person's early twenties and the risk for developing SAD decreases with age (Saeed and Bruce).

What are the symptoms of seasonal affective disorder?
People who suffer from SAD can have the common symptoms of depression such as sadness, anxiety, lost of interest in usual activities, withdrawal from social activities, and an inability to concentrate. Symptoms most common to winter depression include:

Increased sleep

Increased appetite

Weight gain

Irritability

Interpersonal difficulties (especially feelings of rejection)

A heavy leaden feeling in the arms and legs

How is seasonal affective disorder diagnosed?
Physicians can diagnose SAD based on criteria (a set of standards) developed by the American Psychiatric Association. Your physician can determine if you are suffering from depression and if this depression is a seasonal affective disorder. Tables 1 and 2 below list the criteria used for diagnosing a depressive episode and SAD.

What causes SAD?
The exact cause of SAD is unknown, but researchers suspect changes in the availability of sunlight plays an important role. Statistics show that winter depression becomes increasingly more common the farther people live north or south of the equator. Episodes of winter depression also tend to be longer and more severe at higher latitudes (Saeed and Bruce).

How is seasonal affective disorder different from the "holiday blues?"
Many people use the expression "holiday blues" to refer to a sadness or depression occurring during winter or the holiday season. This term should be differentiated from SAD. The holiday blues are related to psychosocial factors such as increased family obligations, isolation, decreased exercise, expectations that one "should" feel good, or association of the holidays with early memories and possible unresolved childhood conflicts.

In contrast, SAD is a subtype of a major depressive disorder (or bipolar disorder) with seasonal patterns and appears to be more biological in origin. (Rosenthal).

How is winter depression treated?
Research now shows that light therapy, or exposure to light, is an effective treatment for winter depression. Light therapy is administered by a 10,000-lux light box, which contains white fluorescent light tubes covered with a plastic screen that blocks ultraviolet rays. Full-spectrum light is not necessary (Saeed and Bruce).

The patient sits in front of the box with his or her eyes open, but should not look directly into the light. The therapy begins with daily sessions of 10 to 15 minutes, which are gradually increased to 30 to 45 minute sessions. Ninety minutes of exposure per day is often prescribed. The therapy typically continues until spring.

When should light therapy by prescribed?

Circumstances supporting the first-line use of light therapy⁵

The patient is not severely suicidal.

There are medical reasons to avoid the use of antidepressants.

Patient has no history of significant negative effects to light therapy.

The patient requests light therapy.

An experienced practitioner deems that light therapy is indicated.

How soon does light therapy work?
Most people notice improvement in 2 to 4 days. In some cases, symptoms may not improve for several weeks. If symptoms are worsening or do not improve after 4 to 6 weeks of therapy, see your physician. You may require a change in treatment.

Does light therapy cause side effects?
Light therapy can cause these side effects (Saeed and Bruce).

Photophobia (eye sensitivity to light)

Headache

Fatigue

Irritability

Hypomania (a mental state characterized by excessive excitability, optimism, hyperactivity, talkativeness, heightened sexual interest, quick anger and irritability and a decreased need for sleep)

Insomnia (if light therapy is used too late in the day)

Possible retinal damage (though this side effect has not been proven)

What other forms of treatment are available?
Treatments that may be helpful for SAD but require further testing include:

Medications (fluoxetine, propranolol, d-fenfluramine, moclobemide, tranylcypromine, bupropion and others)

Counseling (especially interpersonal psychotherapy and cognitive therapy)

Electroconvulsive therapy (finely controlled electrical discharge to induce seizure-like activity in the brain)

(Please see above link for more info.)

Places to purchase:

Instructions to make a weighted blanket

Contributed by Minna Mettinen

Use two existing blankets to do this. Put the pockets on one, and then sew the two blankets together. This is for those who don’t have dollars to go out to buy a weighted blanket. Also this way, a favorite blanket can be turned into a weighted blanket. Use the favorite one, as the cover, over top of the one with the pockets. This way also the pockets can be sewn out of any material at hand, and noone will see what they look like inside, so it also saves on buying materials. Also, the pockets can be filled with various things, even changing them according to how much pressure is needed. Sometimes one can use little baggies made out of dried peas, or little baggies made out of modeling clay, (formed flat to fit the pocket nicely). Also if this is for a child, you may wish to make the pockets larger, so it accommodates more weights as the child grows.

I got a piece of polar fleece that was 2 yards and another that was 3 yards. I cut the extra yard off the one, and used it to make pockets, which I sewed onto one of the pieces of fleece. Then I sewed 3 sides of the 2 big pieces together. I put sticky back velcro on all the pockets, and stuffed them with little baggies filled with clay and lead beebees (this may be too heavy for who you have it in mind for, though-I like TONS AND TONS of pressure). Then I turned it inside in, so the pockets were on the inside, and put sticky back velcro on the side that’s not sewed shut. Now it is washable and the weights may be adjusted to need!

Making your own weighted blanket

Please consult an OT on need & use of weighted blanket so that it is tailored to your child.

Making the blanket

Use two existing blankets to do this. Put the pockets on one, and then sew the two blankets together. This way also the pockets can be sewn out of any material, and no one will see what they look like. The pockets should be large to accommodate the child’s growing needs. Sow the pockets on 3 sides only. Sow Velcro on the inside of the pockets so that you can attach the weight bags as needed. The baggies can be adjusted according to how much pressure is needed. The blanket is washable as you can take out the weights.

OR Make blanket and a weighted vest using regular patterns and by creating little pockets throughout each.

OR Make the weighted blanket from a Velux blanket cut to size width wise. Fold it in half and sow the length of the blanket every four inches. Pour little plastic pellets that you can buy at a craft store into the four inch pockets. Sew the pockets closed.

Weights:
- dried peas
- flaxseeds (inexpensive, safe, conform to the body)

WHAT IS HYPERBARIC OXYGEN THERAPY?

Hyperbaric oxygen therapy (HBOT), as administered at he Mount Rainier Clinic, is a medical treatment during which the entire body is placed in a transparent, airtight chamber at increased atmospheric pressure. The patient is surrounded by and breathes 100 percent pure oxygen. This treatment is proven effective for a number of different medical and surgical conditions either as a primary or adjunctive treatment. It is also used to treat many other medical conditions that are still considered experimental by the mainstream medical establishment—despite decades of reported benefit.

At Mount Rainier Clinic in Yelm, Washington (near Tacoma and Olympia), we utilize Sechrist monoplace hyperbaric chambers. They are large enough to hold a seven-foot patient. The pressure can be increased to as much as three times normal atmospheric pressure (although the usual treatment pressure is twice atmospheric or less). Pure, 100 percent oxygen is continuously maintained and circulated throughout the treatment. There is no need to wear a mask or hood at our clinics because the entire chamber is pressurized with oxygen instead of room air. This method requires much more oxygen per treatment, but provides additional benefit at lower pressures—especially to areas of the body with poor blood flow.

HOW DOES IT WORK?

The earth's atmosphere normally exerts 14.7 pounds per square inch of pressure at sea level. That is equivalent to one atmosphere absolute (abbreviated as 1 ATA). In this atmosphere we breathe approximately 20 percent oxygen and 80 percent nitrogen. During HBOT, the pressure is increased up to two times the normal and the patient breathes 100 percent oxygen while the entire body is totally immersed in 100 percent oxygen. Increased pressure combined with the increase in oxygen content dissolves oxygen into the blood and all other body tissues and fluid at up to 20 times the normal concentration—high enough to sustain life with no blood at all and even with the heart stopped.

DOES THE INCREASED PRESSURE CAUSE DISCOMFORT?

Hyperbaric treatments are painless, but the patient may experience a sensation of “fullness” in the ears, similar to driving down a mountain, flying, or scuba diving. The “full” feeling occurs as the eardrums respond to the change in pressure. The HBOT technician demonstrates how to relieve this fullness before treatment.

WHAT DOES IT FEEL LIKE?

Once a patient is in the chamber and the door is closed, the oxygen begins to circulate. This starts a gradual increase in pressure—called compression. There may be some slight warmth, but that is temporary. The HBOT technician remains by the chamber throughout the treatment to adjust the rate of compression according to patient tolerance and to coach the patient on relieving the “full” sensation in the ears. Compression generally lasts 10-15 minutes depending on how effective one is at clearing their ears.

When the interior of the chamber reaches the prescribed pressure, the sensation of “fullness” in the ears will cease and the patient is free to rest or sleep. The temperature in the chamber remains at room temperature. The patient may also watch TV, listen to music, or chat with family over the intercom during the treatment, which usually lasts one hour.

Near to the end of the treatment, the HBO technician will gradually decrease pressure that was added at the beginning. This is decompression, which generally lasts 10 to 15 minutes. During decompression, there may be a slight “popping” sensation in the ears as a result of the changing (decreasing) pressure. This “popping” is a normal adjustment, similar to what happens when driving up a mountain or ascending in an airplane. It is usually much easier to equalize ear pressure during decompression than during the compression phase.

ARE THERE ANY NEGATIVE AFTER EFFECTS?

Generally patients experience no negative after effects from HBOT. However, some patients report a “cracking” sensation in their ears between treatments as oxygen behind the eardrums is absorbed into the blood stream. This can be relieved in the same manner as clearing the ears during compression and decompression. Also, some patients report feeling light headed for a few minutes immediately following a treatment, but this is brief, and they are quickly able to continue with their normal daily activities such as working or driving.

As with all medical procedures and treatments, some potential after effects may result from exposure to hyperbaric oxygen. These are rare, but will be discussed in detail by the doctor and HBO technician before treatment.

WHAT ARE SOME PREPARATIONS BEFORE HBO THERAPY?

MEDICATIONS: Some medications are not compatible with hyperbaric oxygen therapy. The HBO technician will obtain a complete drug history before treatment. Each drug taken will be considered individually in relation to HBOT, and should changes be indicated, the prescribing doctor will be advised.

Some commonly used medications may potentiate side effects from HBOT. They must be limited or substituted with another drug. These include: high doses of aspirin and prednisone (or similar cortisone type drugs), and morphine, or alcohol within 8 hours of treatment.

Special precautions also are required for HBOT patients who are taking insulin, pain medication, tranquilizers, high doses of prednisone and other corticosteroids, and anticoagulants. The doctor or nurse will explain any needed precautions.

Patients will be instructed to take a regimen of high potency nutritional supplements containing vitamin E and other antioxidants during a course of hyperbaric oxygen therapy. A packet of the Dr. Cranton's AntioxPackets™ multiple supplement plus a 100 mg tablet of alpha lipoid acid should be taken twice daily with meals.

COLDS AND OTHER SYMPTOMS: It is important to notify the HBO technician should symptoms occur of a cold or the flu, fever, cough, sore throat, runny nose, cold sore, nausea, vomiting, diarrhea, or a generalized ache-all-over feeling. Those types of illnesses are not helped by oxygen, so the HBO treatments may need to be postponed until symptoms have subsided and the doctor allows resumption of HBOT.

SMOKING: Nicotine is another substance that is not compatible with HBOT. Once HBOT has been prescribed, patients should stop the use of tobacco in any form until therapy is complete. This “no smoking” rule applies to cigarettes, pipe tobacco, and cigars, as well as chewing tobacco and snuff. If a person just cannot stop the use of tobacco, HBOT will not be as effective.

COSMETICS: Cosmetics, hair spray, nail polish, perfume, or shaving lotion containing a petroleum, alcohol or oil base are not allowed while in the HBO chamber. However, those products may be reapplied after each treatment. It is important to discuss all skin care products with the HBO technician so they may assure safety.

CLOTHING: Patients are provided with 100-percent cotton gowns to wear during treatment. No articles containing nylon or polyester can be worn in the chamber. Watches and other jewelry, dentures, contact lenses and other prosthetic devices will also need to be removed before treatment. It is also important that cleanliness be maintained during the course of treatment.

SCHEDULING: The HBO technician will usually schedule treatments on a daily basis. Every effort will be made to consider personal schedules and other activities of daily living. There may be times when an HBOT appointment must be cancelled or postponed due to emergency situations. If, on the other hand, it is not possible to keep an appointment, the clinic should be notified as soon a possible.

Links for more info on HBOT:

WEIGHTED BLANKETS